Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Non-parenteral postoperative analgesia. A comparison of sublingual buprenorphine and morphine sulphate (slow release) tablets.
Sixty-nine patients undergoing upper and lower abdominal surgery were studied after operation to compare the analgesic effects of sublingual buprenorphine (0.4 mg) and slow release morphine sulphate tablets (MST, 20 mg) given 6 hourly in a double-blind, double-dummy trial. Both MST and buprenorphine produced satisfactory postoperative analgesia but the linear analogue pain scores were significantly lower on the second post operative day with MST.
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A case of respiratory failure following postoperative intercostal nerve blockade is described. A possible mechanism is postulated and the evidence in favour of intercostal blockade in patients with chronic airways disease is questioned. The need for caution when managing such patients with regional blockade is emphasised.
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Randomized Controlled Trial Clinical Trial
Reduction of gastric acid secretion. The efficacy of pre-anaesthetic oral cimetidine in children.
Cimetidine 10 mg/kg orally was given at varying times from 60 to 240 minutes pre-operatively to 100 healthy children between the ages of 6 months and 14 years. Cimetidine proved to be most effective when given between 120 and 180 minutes before the induction of anaesthesia. ⋯ In these patients the mean (SD) half-life of cimetidine was 138 (18) minutes. The reduction of gastric juice volume and acidity produced by 10 mg/kg oral cimetidine given 120-180 minutes prior to induction of anaesthesia has important clinical implications.
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Clinical Trial Controlled Clinical Trial
Mandatory sublingual buprenorphine for postoperative pain.
This study examined the analgesic effect, vital signs and side effects when 0.4 mg doses of buprenorphine were given pre-emptively for the treatment of postoperative pain after elective total hip replacement. Pain intensity, pain relief, retrospective peak pain intensity and pain relief, sedation, vital signs and side effects were measured 1 hour after surgery and then in the morning and evening of the first 2 postoperative days. ⋯ However, there was a significant increase in the number of patients with a pulse rate greater than 100 beats per minute. No particular benefit for postoperative pain relief was observed in patients receiving buprenorphine premedication in comparison with those who had received morphine or placebo.
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Case Reports
Extensive spread of local anaesthetic solution following subdural insertion of an epidural catheter during labour.
A case is described where a small dose of bupivacaine was accidentally injected into the subdural, extra-arachnoid space resulting in extensive unilateral block and hypotension. The spread of solution was confirmed radiologically.